Large Hyperpigmented Perianal Tumor

Ms. H, a 64-year-old widowed female, presented to the emergency department complaining of severe fatigue and weakness with intermittent rectal bleeding lasting several weeks. The patient’s son reported that over the past four months she had experienced a 20-pound weight loss and had been bedbound because of severe diabetes-induced peripheral neuropathy. On physical examination, a large hyperpigmented lesion measuring 6 x 7 cm was found on the right lateral aspect of the anus.